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General NPI Number Information
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NPI Number | 1780882563
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Entity Type | Individual
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Provider Name | LORETTA ANN RISPOLI NP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 MONTAUK HWY GSH TRAUMA NEUROSURGERY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4927
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Country | US
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Telephone | 631-376-3384
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Fax | 631-376-4101
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Provider Business Mailing Address
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Address Line | 145 S BAYVIEW AVE
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City | AMITYVILLE
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State | NY
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Zip | 11701-3801
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Country | US
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Telephone | 631-691-3780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 334852
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License Number State | NY
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